The impact of chronic hepatitis B infection on major adverse cardiovascular events and all-cause mortality in patients with diabetes: A nationwide population-based study from Taiwan

Chin Sung Kuo, Yung Tai Chen, Chien Yi Hsu, Chun Chin Chang, Ruey Hsing Chou, Szu Yuan Li, Shu Chen Kuo, Po Hsun Huang, Jaw Wen Chen, Shing Jong Lin

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Objectives: The association between hepatitis B virus (HBV) infection and cardiovascular disease remains uncertain. This study explored long-term hard endpoints (ie, myocardial infarction and ischaemic stroke) and all-cause mortality in diabetic patients with chronic HBV infection in Taiwan from 2000 to 2013. Design: This study was retrospective, longitudinal and propensity score-matched. Setting Nationwide claims data for the period 2000-2013 were retrieved from Taiwan's National Health Insurance Research Database. Participants: The study included 40 162 diabetic patients with chronic HBV infection (HBV cohort) and 40 162 propensity score-matched diabetic patients without HBV infection (control cohort). Chronic HBV infection was identified based on three or more outpatient clinic visits or one hospital admission with a diagnosis of HBV infection. Main outcome measures: Primary outcomes were major adverse cardiovascular events (MACE, including myocardial infarction and ischaemic stroke), heart failure and all-cause mortality. Results: During the median follow-up period of 5.3±3.4 years, the HBV cohort had significantly lower risks of myocardial infarction (adjusted HR (aHR)=0.49; 95% CI 0.42 to 0.56), ischaemic stroke (aHR=0.61; 95% CI 0.56 to 0.67), heart failure (aHR=0.50; 95% CI 0.43 to 0.59) and all-cause mortality (aHR=0.72; 95% CI 0.70 to 0.75) compared with the control cohort. The impact of HBV infection on the sequential risk of MACE was greater in patients with fewer diabetic complications. Conclusions: Chronic HBV infection was associated with decreased risk of MACE, heart failure and all-cause mortality in patients with diabetes. Further research is needed to investigate the mechanism underlying these findings.

Original languageEnglish
Article numbere016179
JournalBMJ Open
Volume7
Issue number8
DOIs
Publication statusPublished - Aug 1 2017

Fingerprint

Chronic Hepatitis B
Taiwan
Hepatitis B virus
Virus Diseases
Mortality
Infection
Population
Propensity Score
Heart Failure
Stroke
Myocardial Infarction
National Health Programs
Diabetes Complications
Ambulatory Care
Infection Control
Ambulatory Care Facilities
Research
Cardiovascular Diseases
Retrospective Studies
Outcome Assessment (Health Care)

Keywords

  • atherosclerosis
  • diabetes
  • hepatitis B virus
  • ischaemic stroke
  • myocardial infarction

ASJC Scopus subject areas

  • Medicine(all)

Cite this

The impact of chronic hepatitis B infection on major adverse cardiovascular events and all-cause mortality in patients with diabetes : A nationwide population-based study from Taiwan. / Kuo, Chin Sung; Chen, Yung Tai; Hsu, Chien Yi; Chang, Chun Chin; Chou, Ruey Hsing; Li, Szu Yuan; Kuo, Shu Chen; Huang, Po Hsun; Chen, Jaw Wen; Lin, Shing Jong.

In: BMJ Open, Vol. 7, No. 8, e016179, 01.08.2017.

Research output: Contribution to journalArticle

Kuo, Chin Sung ; Chen, Yung Tai ; Hsu, Chien Yi ; Chang, Chun Chin ; Chou, Ruey Hsing ; Li, Szu Yuan ; Kuo, Shu Chen ; Huang, Po Hsun ; Chen, Jaw Wen ; Lin, Shing Jong. / The impact of chronic hepatitis B infection on major adverse cardiovascular events and all-cause mortality in patients with diabetes : A nationwide population-based study from Taiwan. In: BMJ Open. 2017 ; Vol. 7, No. 8.
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abstract = "Objectives: The association between hepatitis B virus (HBV) infection and cardiovascular disease remains uncertain. This study explored long-term hard endpoints (ie, myocardial infarction and ischaemic stroke) and all-cause mortality in diabetic patients with chronic HBV infection in Taiwan from 2000 to 2013. Design: This study was retrospective, longitudinal and propensity score-matched. Setting Nationwide claims data for the period 2000-2013 were retrieved from Taiwan's National Health Insurance Research Database. Participants: The study included 40 162 diabetic patients with chronic HBV infection (HBV cohort) and 40 162 propensity score-matched diabetic patients without HBV infection (control cohort). Chronic HBV infection was identified based on three or more outpatient clinic visits or one hospital admission with a diagnosis of HBV infection. Main outcome measures: Primary outcomes were major adverse cardiovascular events (MACE, including myocardial infarction and ischaemic stroke), heart failure and all-cause mortality. Results: During the median follow-up period of 5.3±3.4 years, the HBV cohort had significantly lower risks of myocardial infarction (adjusted HR (aHR)=0.49; 95{\%} CI 0.42 to 0.56), ischaemic stroke (aHR=0.61; 95{\%} CI 0.56 to 0.67), heart failure (aHR=0.50; 95{\%} CI 0.43 to 0.59) and all-cause mortality (aHR=0.72; 95{\%} CI 0.70 to 0.75) compared with the control cohort. The impact of HBV infection on the sequential risk of MACE was greater in patients with fewer diabetic complications. Conclusions: Chronic HBV infection was associated with decreased risk of MACE, heart failure and all-cause mortality in patients with diabetes. Further research is needed to investigate the mechanism underlying these findings.",
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T1 - The impact of chronic hepatitis B infection on major adverse cardiovascular events and all-cause mortality in patients with diabetes

T2 - A nationwide population-based study from Taiwan

AU - Kuo, Chin Sung

AU - Chen, Yung Tai

AU - Hsu, Chien Yi

AU - Chang, Chun Chin

AU - Chou, Ruey Hsing

AU - Li, Szu Yuan

AU - Kuo, Shu Chen

AU - Huang, Po Hsun

AU - Chen, Jaw Wen

AU - Lin, Shing Jong

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N2 - Objectives: The association between hepatitis B virus (HBV) infection and cardiovascular disease remains uncertain. This study explored long-term hard endpoints (ie, myocardial infarction and ischaemic stroke) and all-cause mortality in diabetic patients with chronic HBV infection in Taiwan from 2000 to 2013. Design: This study was retrospective, longitudinal and propensity score-matched. Setting Nationwide claims data for the period 2000-2013 were retrieved from Taiwan's National Health Insurance Research Database. Participants: The study included 40 162 diabetic patients with chronic HBV infection (HBV cohort) and 40 162 propensity score-matched diabetic patients without HBV infection (control cohort). Chronic HBV infection was identified based on three or more outpatient clinic visits or one hospital admission with a diagnosis of HBV infection. Main outcome measures: Primary outcomes were major adverse cardiovascular events (MACE, including myocardial infarction and ischaemic stroke), heart failure and all-cause mortality. Results: During the median follow-up period of 5.3±3.4 years, the HBV cohort had significantly lower risks of myocardial infarction (adjusted HR (aHR)=0.49; 95% CI 0.42 to 0.56), ischaemic stroke (aHR=0.61; 95% CI 0.56 to 0.67), heart failure (aHR=0.50; 95% CI 0.43 to 0.59) and all-cause mortality (aHR=0.72; 95% CI 0.70 to 0.75) compared with the control cohort. The impact of HBV infection on the sequential risk of MACE was greater in patients with fewer diabetic complications. Conclusions: Chronic HBV infection was associated with decreased risk of MACE, heart failure and all-cause mortality in patients with diabetes. Further research is needed to investigate the mechanism underlying these findings.

AB - Objectives: The association between hepatitis B virus (HBV) infection and cardiovascular disease remains uncertain. This study explored long-term hard endpoints (ie, myocardial infarction and ischaemic stroke) and all-cause mortality in diabetic patients with chronic HBV infection in Taiwan from 2000 to 2013. Design: This study was retrospective, longitudinal and propensity score-matched. Setting Nationwide claims data for the period 2000-2013 were retrieved from Taiwan's National Health Insurance Research Database. Participants: The study included 40 162 diabetic patients with chronic HBV infection (HBV cohort) and 40 162 propensity score-matched diabetic patients without HBV infection (control cohort). Chronic HBV infection was identified based on three or more outpatient clinic visits or one hospital admission with a diagnosis of HBV infection. Main outcome measures: Primary outcomes were major adverse cardiovascular events (MACE, including myocardial infarction and ischaemic stroke), heart failure and all-cause mortality. Results: During the median follow-up period of 5.3±3.4 years, the HBV cohort had significantly lower risks of myocardial infarction (adjusted HR (aHR)=0.49; 95% CI 0.42 to 0.56), ischaemic stroke (aHR=0.61; 95% CI 0.56 to 0.67), heart failure (aHR=0.50; 95% CI 0.43 to 0.59) and all-cause mortality (aHR=0.72; 95% CI 0.70 to 0.75) compared with the control cohort. The impact of HBV infection on the sequential risk of MACE was greater in patients with fewer diabetic complications. Conclusions: Chronic HBV infection was associated with decreased risk of MACE, heart failure and all-cause mortality in patients with diabetes. Further research is needed to investigate the mechanism underlying these findings.

KW - atherosclerosis

KW - diabetes

KW - hepatitis B virus

KW - ischaemic stroke

KW - myocardial infarction

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